BVA9502742
DOCKET NO. 94-02 155 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in Chicago,
Illinois
THE ISSUE
Entitlement to an increased rating for postoperative residuals of
a rectal/anal stricture with hemorrhoids and fissure, currently
evaluated as 30 percent disabling.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
The appellant
ATTORNEY FOR THE BOARD
Frank L. Christian, Counsel
INTRODUCTION
The veteran served on active duty from April 1943 to March 1946.
This matter comes before the Board of Veterans' Appeals (Board)
on appeal from a rating decision of the Department of Veterans
Affairs (VA) Regional Office (RO) in Chicago, Illinois.
Issues of entitlement to secondary service connection for
postoperative residuals of an umbilical hernia and a temporary
total disability rating based on hospitalization in March 1992
were resolved by rating decision of July 1992. The Board limits
its consideration herein to the single issue stated on the title
page of this decision.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends that the RO committed error in failing to
grant a rating in excess of 30 percent for his service-connected
postoperative residuals of a rectal/anal stricture with
hemorrhoids and fissure because it did not take into account or
properly weigh the medical and other evidence of record. It is
contended that the appellant experiences a painful rectal
stricture or mass, mucous and fecal leakage with soiling of his
undergarments 3 to 4 times daily, bleeding and itching of scar
tissue in the rectal area, anal stenosis, and intermittent
constipation requiring digital extraction. It is contended that
an evaluation of 50 percent would more appropriately reflect the
appellant's current level of disability stemming from this
disorder.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that the evidence of record supports the assignment of an
increased rating of 50 percent for postoperative residuals of a
rectal/anal stricture with hemorrhoids and fissure.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable disposition
of the instant appeal has been obtained by the RO.
2. The veteran's service-connected postoperative residuals of a
rectal/anal stricture with hemorrhoids and fissure are currently
manifested by a painful rectal stricture or mass, a great
reduction of lumen, and frequent episodes of mild fecal leakage
with mild to moderate soiling of undergarments.
CONCLUSION OF LAW
An increased rating of 50 percent is warranted for postoperative
residuals of rectal/anal stricture with hemorrhoids and fissure.
38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, § 4.7, Code
7333 (1994).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The veteran's claim is plausible and thus "well grounded" within
the meaning of 38 U.S.C.A. § 5107(a) (West 1991), which mandates
a duty to assist the veteran in developing all pertinent
evidence. Our review of the record in this case shows that the
RO has obtained medical evidence from all sources identified by
the veteran, that he was afforded VA disability compensation
examinations in August 1992 and in March 1993, and that he
testified at a personal hearing on appeal held at the RO in
January 1994. We see no areas in which further development might
be productive.
The veteran's service medical records show that he underwent a
hemorrhoidectomy and repair of an anal fissure in November 1944.
In April 1945, he was hospitalized for evaluation and treatment
of a rectal stricture. Examination disclosed a thread-like band
of scar tissue encircling the anus at the mucocutaneous junction.
Two small hemorrhoids were visible and a rectal stricture was
present in the line of the hemorrhoidectomy. The rectum was
dilated under spinal anesthesia. The diagnosis was stricture,
anus, secondary to hemorrhoidectomy in November 1944.
A report of VA examination in May 1951 disclosed the presence of
an anal stricture, hemorrhoids, and an anal fissure. A rating
decision of June 1951 granted service connection for a
rectal/anal stricture with postoperative residuals of hemorrhoids
and an anal fissure, evaluated as 30 percent disabling from March
1951.
In January 1978, the veteran underwent a partial posterior anal
sphincterotomy and excision of multiple hypertrophied papillae.
A rating decision of April 1978 granted a temporary total
disability rating due to hospitalization, then continued the
previous 30 percent evaluation from March 1978.
A March 1992 letter from S. J. Mendak, Jr., M.D., stated, in
pertinent part, that he had recommended that the veteran take
Metamucil or laxatives to avoid straining at stool due to
constipation. He was further advised to avoid heavy lifting.
A June 1992 letter from S. Matlin, M.D., stated that the veteran
was seen in June 1992 for complaints of anal discomfort and pain
caused from daily straining at stool. Examination of the rectal
and anal connal disclosed a great reduction of lumen, with
moderate leakage. Rectal stenosis was described as "most
severe," and surgery was recommended. Pending that surgery, the
veteran was asked to refrain from heavy lifting and to continue
to use stool softeners.
In July 1992, the veteran claimed entitlement to a rating in
excess of 30 percent for his service-connected postoperative
residuals of a rectal/anal stricture with hemorrhoids and
fissure.
A report of VA examination conducted in August 1992 cited the
veteran's complaints of occasional incontinence, frequent
constipation secondary to anal stenosis requiring digital
extraction, and occasional bleeding from the anoderm when he has
diarrhea. Examination disclosed moderate to severe anal stenosis
with mild incontinence (leakage and flatus), intermittent
constipation, and mild scarring of the perirectal tissue (skin of
the anoderm), without visible hemorrhoids or occult blood. The
examiner indicated that he would expect no improvement without
surgery and that recurrence of stenosis following surgery was
well-known.
A report of VA examination conducted in March 1993 cited the
veteran's complaints of constant mucus and fecal leakage soiling
his undergarments, requiring that he change twice daily, as well
as increasing pain from his rectal stricture when passing stool
or constipated, and constant itching and chafing in the rectal
area. Examination disclosed frequent episodes of mild fecal
leakage with mild to moderate soiling of undergarments, and
frequent tenesmus (straining at stool), without current evidence
of bleeding, incontinence, dehydration, malnutrition, or anemia.
A normal sphincter tone was present and examination of the anal
surface revealed slight post surgical changes but no fissures or
prolapsing hemorrhoids. The examiner stated that the problem
appeared to be anal muscle spasm with a small amount of
persistent mucus drainage secondary to post surgical changes. He
characterized the problem as mild and stated that it should
improve if the veteran used Metamucil on a regular basis,
together with regular Sitz baths to reduce rectal muscle spasm.
He offered the opinion that surgical correction of this problem
might be difficult.
Letters from P. V. Kisielius, M.D., dated in March 1993, showed
that, on examination of the veteran in February 1993, he
encountered an obstruction when passing a probe into the
veteran's rectum, and that it was "very painful" to him. He
stated that he suspected that the veteran had a rectal stricture
or mass.
A personal hearing on appeal was held at the RO in January 1994
before a traveling member of the Board. The veteran testified
that he experienced a painful rectal stricture or mass, daily
mucus and fecal leakage with soiling of his undergarments 3 to 4
times daily, bleeding and itching of scar tissue in the rectal
area, anal stenosis, and intermittent constipation requiring
digital extraction. A transcript of his testimony is of record.
Disability evaluations are determined by the application of a
schedule of ratings which is based on average impairment of
earning capacity. 38 U.S.C.A. § 1155 (West 1991), 38 C.F.R. Part
4(1994). Separate diagnostic codes identify the various
disabilities. Where there is a question as to which of two
evaluations shall be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates the
criteria required for that rating. Otherwise, the lower rating
will be assigned. 38 C.F.R. § 4.7 (1994).
The Schedule for Rating Disabilities provides that a 30 percent
evaluation is warranted for stricture of the rectum and anus with
a moderate reduction of the lumen or moderate constant leakage.
A 50 percent evaluation requires great reduction of the lumen or
extensive leakage. 38 C.F.R. Part 4, Code 7333 (1994).
The medical evidence of record shows that the veteran's service-
connected postoperative residuals of rectal/anal stricture with
hemorrhoids and fissure are currently manifested by a painful
rectal stricture or mass, a great reduction of lumen, and
frequent episodes of mild to moderate fecal leakage with mild to
moderate soiling of undergarments. We have considered the
veteran's testimony and find it credible. The statements by Dr.
Matlin that his examination of the veteran disclosed "most
severe" anal stenosis and "great reduction of lumen" is
uncontradicted in the medical record. The rating schedule
requires great reduction of the lumen or extensive leakage for a
50 percent evaluation, not both (emphasis added). We find that a
great reduction in the lumen and a persistent, moderate daily
fecal leakage are clinically demonstrated, and that an increased
rating of 50 percent is warranted.
Consideration has also been given to other provisions of 38
C.F.R. Parts 3 and 4(1994). An extraschedular rating under 38
C.F.R.§ 3.321(b)(1)(1994)is not warranted since factors such as
frequent hospitalizations and marked interference with employment
are not present so as to exclude the use of the regular schedular
standards.
ORDER
An increased rating of 50 percent for postoperative residuals of
rectal/anal stricture with hemorrhoids and fissure is granted,
subject to controlling regulations governing the payment of
monetary benefits.
J. U. JOHNSON
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988. Veterans' Judicial
Review Act, Pub. L. No. 100-687, § 402 (1988). The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.